盆底三维超声在压力性尿失禁诊断及TVT-O术后疗效评估中的应用价值

The value of pelvic floor three-dimensional ultrasound in the diagnosis of stress urinary incontinence and the evaluation of curative effect after TVT-O

目的分析盆底三维超声对压力性尿失禁(SUI)患者的诊断价值及进行经闭孔无张力尿道中断悬吊(TVT-O)手术后疗效的评估价值。方法选择2018年1月—2020年2月本院收治的压力性尿失禁患者80例作为研究对象,设为观察组;另选同期体检正常女性75名为对照组。两组均进行实时盆底三维超声检查,分析静息期与Valsalva状态下,膀胱尿道后角、耻骨直肠肌厚度、盆膈裂孔面积情况,采用受试者工作特征(ROC)曲线分析静息期与Valsalva动作后每个检查参数对压力性尿失禁患者的诊断价值及对观察组患者预后的预测价值。结果观察组静息期、Valsalva状态下膀胱尿道后角、盆膈裂孔面积显著高于对照组;耻骨直肠肌厚度显著低于无效患者,差异具有统计学意义(P<0.05)。静息期膀胱尿道后角、耻骨直肠及厚度、盆膈裂孔面积;Valsalva状态下膀胱尿道后角、耻骨直肠及厚度、盆膈裂孔面积对观察组的诊断AUC分别为0.922、0.904、0.730、0.908、0.934、0.725。根据随访结果治疗有效患者58例、无效患者22例;对其治疗后三维盆底超声参数进行分析显示:静息期、Valsalva状态下膀胱尿道后角、盆膈裂孔面积显著低于无效患者;耻骨直肠肌厚度显著高于无效患者,差异具有统计学意义(P<0.05)。静息期膀胱尿道后角、耻骨直肠及厚度、盆膈裂孔面积;Valsalva状态下膀胱尿道后角、耻骨直肠及厚度、盆膈裂孔面积预测治疗有效患者的AUC分别为0.922、0.904、0.730、0.908、0.934、0.725。结论盆底三维超声对SUI患者具有较高的诊断价值,同时对进行TVT-O手术的SUI患者疗效具有较好的预测价值。

Objective To analyze the value of pelvic floor three-dimensional ultrasound in patients with stress urinary incontinence(SUI)and its value in evaluating the efficacy of tension free vaginal tape obturator(TVT-O)surgery.Methods 80 patients with stress urinary incontinence those admitted to our hospital from January 2018 to February 2020 were selected as the observation group,and another 75 normal women were selected as the control group.Real time three-dimensional pelvic floor ultrasound was performed in both groups.The posterior angle of bladder and urethra,the thickness of puborectal muscle and the area of pelvic diaphragm hiatus were analyzed at rest and Valsalva state.Receiver operator characteristic(ROC)curvewas used to analyze the diagnostic value of each examination parameter in the resting period and after Valsalva maneuver for patients with stress urinary incontinence and the predictive value for the prognosis of patients in the observation group.Results The posterior angle of bladder and urethra and area of pelvic diaphragmatic hiatus in the observation group was significantly higher than that in the control group at rest and Valsalva state;the thickness of puborectal muscle was significantly lower than that in the invalid patients,the difference was statistically significant(P<0.05).According to the analysis results,the AUC of bladder urethra posterior angle,puborectal thickness and pelvic diaphragmatic hiatus area in resting period and in Valsalva state were 0.922,0.904,0.730,0.908,0.934 and 0.725 respectively.According to the follow-up results,58 patients were effective and 22 patients were ineffective.The analysis of three-dimensional pelvic floor ultrasound parameters after treatment showed that the posterior angle of bladder and urethra and area of pelvic diaphragm hiatus during resting period and at Valsalva state in effective patients were significantly lower than those in ineffective patients;the thickness of puborectal muscle was significantly higher than that in ineffective patients,and the differences were statistically significant(P<0.05).According to the analysis results,the AUC of bladder urethra posterior angle,puborectal thickness and pelvic diaphragmatic hiatus area both at rest and Valsalva state were 0.922,0.904,0.730,0.908,0.934 and 0.725 respectively.Conclusions The three-dimensional ultrasound of pelvic floor has a high diagnostic value for patients with SUI,and it has a good predictive value for the efficacy of patients undergoing TVT-O operation.